Obese cancer patients often shorted on chemo doses

In this Thursday, Sept. 5, 2013 photo, Tracy Smith looks out of a window at the infusion center at Duke Cancer Center in Durham, N.C. Smith was treated at Duke in 2011 for breast cancer that had spread to more than a dozen lymph nodes. Doctors gave her full chemo doses based on her weight. Three times, high fevers put her in the hospital, and one infusion was cut short because doctors thought it was causing wheezing and possible lung damage. But she resumed and finished the intended treatment an
— AP

In this Thursday, Sept. 5, 2013 photo, Tracy Smith looks out of a window at the infusion center at Duke Cancer Center in Durham, N.C. Smith was treated at Duke in 2011 for breast cancer that had spread to more than a dozen lymph nodes. Doctors gave her full chemo doses based on her weight. Three times, high fevers put her in the hospital, and one infusion was cut short because doctors thought it was causing wheezing and possible lung damage. But she resumed and finished the intended treatment an
/ AP

That happened to Tracy Smith, a 46-year-old Durham, N.C., woman treated at Duke in 2011 for breast cancer that had spread to more than a dozen lymph nodes. Doctors gave her full chemo doses based on her weight, which at 285 pounds classified her as obese.

Three times, high fevers put her in the hospital, and one treatment was cut short because doctors thought it was causing wheezing and possible lung damage. But she resumed and finished the intended treatment and has been cancer-free since then.

After hearing you have cancer, "you're just kind of in a fog" and don't think to ask about doses of the drugs you need, she said. "I trusted my doctor. Doctors should be well aware of what you can tolerate. You should do whatever you can to fight this beast."

Smith's tumor was fueled by estrogen - a hormone made in abundance by fat tissue. Robin McRath, a floral designer who helps run a women's shelter in Ludington, Mich., had the same type.

"It's like a playground, an amusement park, for cancer cells when you're fat," she said. She was only was 41 when her cancer was diagnosed five years ago, and her oncologist, Dr. Carol Peterson, treated her with full doses based on her weight - about 240 pounds, which put her in the obese category.

"We didn't discuss dosage. That didn't matter to me - I just wanted to get it out of my system," she said of the cancer, and praised the treatments to prevent one of chemo's most feared side effects. "There are fantastic anti-nausea medicines. I was never sick one day."

McRath is active in the Obesity Action Coalition, an education and advocacy group. A spokesman said the group was unaware of the dosing issue for obese patients.

Not all doctors are aware either. Luckily for McRath, hers was. Peterson said she uses full doses unless a patient has other health issues.

"If that's their only problem - if they're just overweight or obese - they can do quite well" with full weight-based doses, she said.

Duke's Lyman agreed, and offered this advice to patients: "Ask your doctor how they plan to treat you and whether you're going to get the full dosing. The doctor may have a good reason not to, but you should have that discussion."

---

AP National Writer Allen G. Breed in Raleigh, N.C., contributed to this report.